Herpes Simplex

Mostly appear around the mouth and nose, often called "cold sores", usually heal within seven to fourteen days, however more severe outbreaks may occur, lasting for longer periods for HIV patients. It is possible for the herpes infection to spread into the body with symptoms being high fever, mental confusion, headaches and weakness.

A skin rash due to the reactivation of the dormant chickenpox virus, herpes zoster or shingles, usually appears in a band like pattern to a specific area on one side of the body. Severe pain is involved due to the inflammation of the infected nerves in the area of the rash. This can last for several weeks and spread to other parts of the body with blisters similar to chickenpox. Topical lotions and anti-viral medications may be helpful with the blisters.

Molluscum Contagiosum
Skin lesions common in children and appear as a smooth waxy skin coloured bumps that may continue to develop at different sites. They can vary in size from that of a pin to the size of a large pea. The lesions have a central core filled with white cheese like material and they are not painful or itchy. They are treated by freezing or removing the centre of the lesion.

Warts
Common, benign, painless growths caused by the papilloma virus occurs on the skin usually hands, feet or face. Can also be seen on genital and anal regions. The warts in HIV infected people usually are larger, more numerous and more widespread and can be particularly resistant to standard treatments.

Oral "Hairy" Leukoplakia
Unusual condition which most often occurs on the tongue seen as a small light fuzzy patch due to the Epstein-barr virus. Most often not treated as it is totally asymptomatic.

Oral Candidiasis ‘Thrush’
A yeast infection found in mouth, vagina, skin folds under arms, buttocks and groin repeatedly and frequently occurs in many HIV patients. In the mouth it appears as white curd like patches and can cause soreness of the mouth or throat, provide swallowing difficulties and loss of taste. Can sometimes spread into the oesophagus causing burning sensations when swallowing. The yeast infection can be seen as a severe itchy red rash involving the groin, genitals and buttock which can be treated by creams and tablets.

Tinea
Another fungal infection occurring in the scalp, hands, feet and nails and can be treated with topical or oral medications are more common in people with HIV.

A bacterial skin infection commonly seen in HIV patients causes the development of multiple clusters of small soft fluid filled blisters which break easily oozing a yellowish liquid. When the blister are broken a large shallow ulcer remains with a yellowish crust. It is important that careful observation is required of these skin lesions as there is a possibility that the bacterial infection with spread into the bloodstream.

Skin cancer lesions caused by the herpes virus, do not hurt or itch and can appear anywhere in the body or mouth. Vary from pink to dark red, purple or brown and often mistaken for insect bites, birth marks or bruises. Range from size of pin to that of a large coin and continue to develop into thickened bumps or large tumor growths. There may be more than one lesion. Kaposi’s sarcoma can involve lymph nodes and also internal organs. Lesions on face or exposed areas can be removed surgically or treated with injections or x-ray therapy.

Skin cancers
Lymphomas, producing skin bumps, melanoma or BCC’s are more common in HIV patients. Standard treatments for HIV patients are used for these conditions.

Seborrhoeic Dermatitis
A flaky red inflammatory condition of the skin affecting the face (cheeks, forehead, eyebrows, nose and ears). Can also occur on the scalp as "dandruff". The rash can occur on the chest and inner groin. Often requiring more vigorous treatment in HIV patients various creams and ointments are required.

Psoriasis
Previous history of psoriasis can see HIV patients a worsening of the condition and is often more resistant.

Hives, Papular Urticaria and ‘Itchy Red Bump Disease
A widespread itching skin condition which manifests as tiny red bumps the size of a small pea. Larger patches of hives may occur and these itchy lesions are recurrent, requiring large doses of antihistamines or topical steroid creams.

Folliculitis
Acne like eruptions occurring around hair follicles on the chest, back, face, scalp, legs and buttocks, can be quite itchy and associated with hives. The scratching can cause skin infections. It is treated with a combination of tablets and topically applied lotions and may respond to ultraviolet light.

Facial lipoatrophy
Is the redistribution of body fat, also known as lipodystrophy that occurs in people living with HIV. Lipodystrophy is a characteristic disorder of adipose (fatty) tissue. This is due to both the infection itself along with its antiviral treatment. Its main features are fat loss affecting the face, limbs and buttocks, accompanied by central fat accumulation in the abdomen and breasts and over the dorsocervical spine (the ‘buffalo hump’). Facial lipoatrophy is the most visible component of this disorder. For information on Lipoatrophy treatment click here.

HIV Skin Conditions

Dr Margot Whitfeld

Dr Margot Whitfeld has been conducting an HIV Dermatology Clinic at the Skin & Cancer Foundation for more than 15 years, after completing a Fellowship in HIV Dermatology at San Francisco General…

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